Individual provider Active NPI

Kimberly Laura Cunningham, O.D.

  • Optometrist
  • Mesa, AZ
National Provider Identifier
1992936298
Registry record updated Aug 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1971 Issued in AZ
Practice address
955 W Southern Ave Ste 122
Mesa, AZ 85210-4903
Phone
(480) 835-4440
Fax
(480) 835-8882
NPI assigned
Aug 4, 2009
Last updated
Aug 26, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1971 AZ Primary
Optometrist 152W00000X 2741 CO

Addresses

Primary practice location

955 W Southern Ave Ste 122
Mesa, AZ 85210-4903

Mailing address

PO Box 201764
Dallas, TX 75320-1764
Phone (636) 200-4393

Other practice location 1

2450 E Guadalupe Rd Ste 107
Gilbert, AZ 85234-5116
Phone (480) 507-0600

Other practice location 2

8404 E Shea Blvd Ste 105
Scottsdale, AZ 85260-6658
Phone (480) 483-0711

Other practice location 3

19052 N R H Johnson Blvd
Sun City West, AZ 85375-4401
Phone (623) 232-0560

Other practice location 4

10701 W Bell Rd
Sun City, AZ 85351-1074
Phone (623) 888-8191

Other practice location 5

500 W Savage St
Wickenburg, AZ 85390-4235
Phone (928) 415-2188

Other practice location 6

2222 E Camelback Rd Ste 250
Phoenix, AZ 85016-3427
Phone (602) 840-3501

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090930000242 TX Practitioner - Optometry 0749326080 Reassigns benefits to 1 organization
I20250909003528 AZ Practitioner - Optometry 0749326080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emilio Martin Justo MD PCGroup PAC ID 4183600810, 12 clinicians

Practice addresses (Care Compare)

4212 N 16TH St
Phoenix, AZ 85016-5319
Phone (602) 263-1200

955 W Southern Ave
Suite 122
Mesa, AZ 85210-4903
Phone (480) 835-4440

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2741COMDOptometrist
4829MAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm Current Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm. CurrentSince Jan 16, 2015 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Jan 16, 2015 Accepting new patients
Emilio Martin Justo MD PC CurrentSince Oct 1, 2025 Accepting new patients

Locations

2121 W Reservation Loop Rd
Camp Verde, AZ 86322
Phone (929) 567-2168

2450 E Guadalupe Rd
Ste 107
Gilbert, AZ 85234
Phone (480) 507-0600

955 W Southern Ave
Ste 122
Mesa, AZ 85210
Phone (480) 655-0741

2222 E Camelback Rd
Ste 250
Phoenix, AZ 85016
Phone (602) 265-2745

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

10005 E Osborn Rd
Scottsdale, AZ 85256
Phone (480) 362-7400

8404 E Shea Blvd
Ste 105
Scottsdale, AZ 85260
Phone (480) 483-0711

10701 W Bell Rd
Sun City, AZ 85351
Phone (623) 876-2020

19052 N R H Johnson Blvd
Sun City West, AZ 85375
Phone (623) 232-0560

500 W Savage St
Wickenburg, AZ 85390
Phone (623) 474-3937

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756166400000",
    "number": "1992936298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 201764",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753201764",
            "telephone_number": "636-200-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W SOUTHERN AVE STE 122",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852104903",
            "telephone_number": "480-835-4440",
            "fax_number": "480-835-8882"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 E Guadalupe Rd Ste 107",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852345116",
            "country_code": "US",
            "telephone_number": "480-507-0600",
            "fax_number": "480-558-7162",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8404 E Shea Blvd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Scottsdale",
            "state": "AZ",
            "postal_code": "852606658",
            "country_code": "US",
            "telephone_number": "480-483-0711",
            "fax_number": "480-483-8535",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19052 N R H Johnson Blvd",
            "address_purpose": "LOCATION",
            "city": "Sun City West",
            "state": "AZ",
            "postal_code": "853754401",
            "country_code": "US",
            "telephone_number": "623-232-0560",
            "fax_number": "623-977-6911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10701 W Bell Rd",
            "address_purpose": "LOCATION",
            "city": "Sun City",
            "state": "AZ",
            "postal_code": "853511074",
            "country_code": "US",
            "telephone_number": "623-888-8191",
            "fax_number": "623-977-6911",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 W Savage St",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853904235",
            "country_code": "US",
            "telephone_number": "928-415-2188",
            "fax_number": "928-684-0387",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2222 E Camelback Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850163427",
            "country_code": "US",
            "telephone_number": "602-840-3501",
            "fax_number": "602-840-3671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "KIMBERLY",
        "middle_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-04",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1971",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2741",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.